Displaying 1 - 3 of 3
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 5281AA VISAG 0.1% EYE DR (LPO/COL) AZITHROMYCIN 2.5ML BQ 8.43 0.1% 0 2022-04-01 2024-03-31 6
41 5281AA VISAG 0.1% EYE DR (LPO) AZITHROMYCIN (BQ) 2.5ML BQ 8.4268 0.1% 1 2024-04-01 2026-03-31 0
42 5281AA VISAG 0.1% EYE DR (LPO) AZITHROMYCIN 2.5ML BQ 20.39 0.1% 1 2026-04-01 No No 0